Erfan Bashar
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Headache Epidemiology

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Educational scope notice: This is a study note for medical students, not medical advice, diagnosis, or treatment guidance. Clinical management should follow local protocols and current guidelines.

Headache disorders affect about 40% of people, an estimated 3.1 billion worldwide in 2021. They rank among the top three neurological conditions from age 5 to 80. They are more common in females.

Tension-type headache is the most common primary headache. Episodic tension-type headache, meaning fewer than 15 headache days per month, is reported by more than 70% of some surveyed populations. Chronic tension-type headache is unremitting and more disabling. The same 15-day line separates episodic from chronic forms.

Migraine affected about 1.16 billion people in 2021, up from about 733 million in 1990. Absolute rates are higher in females, but the rise was fastest in males and in adolescents under 20. Migraine typically begins at puberty and peaks at ages 35–45. A typical attack lasts 4–72 hours with nausea or sensitivity to light and sound, sometimes preceded by reversible aura.

Cluster headache is rare, affecting up to 1 in 1000 people. It is male-predominant. Modern clinic series give a ratio around 2.5 men to each woman, while older population figures reach 6 to 1. The ratio falls with age and over time. Untreated attacks last 15 minutes to 3 hours, averaging 45–90 minutes. Mean onset is in the third decade of life.

Chronic migraine means headache on at least 15 days per month for more than 3 months, with migraine features on at least 8 of those days. Characterizing frequent headache requires a diary kept over at least 1 month.

These patterns set pre-test probability before pattern recognition begins. Bilateral pressure in a busy adult is most often tension-type headache. Recurrent disabling attacks with nausea favor migraine. A pacing patient with a red tearing eye points strongly toward cluster headache. The patterns themselves are described in /notes/neurology/headache-clinical-presentation/.

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